E11.359 ICD-10-CM Code: Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Diabetes mellitus (E08-E13)
E11.359
Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidanceType 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema
Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for E11.359 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for E11.359 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for E11.359 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for E11.359 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for E11.359 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for E11.359 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for E11.359 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
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What This Code Means
E11.359 is the ICD-10-CM diagnosis code for type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema. E11.359 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering diabetes mellitus (e08-e13).
Type 2 diabetes with proliferative diabetic retinopathy without macular edema, unspecified eye. Documentation must support PDR, no macular edema, laterality unspecified.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E11.359 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Type 2 diabetes with proliferative diabetic retinopathy without macular edema, unspecified eye. Documentation must support PDR, no macular edema, laterality unspecified.
- •Do not use E11.359 when laterality is documented, E11.3591 (right), E11.3592 (left), E11.3593 (bilateral) apply. Also distinguish with-edema (E11.3511-3519) vs without-edema (E11.3591-3599) subcategories.
- •V28 HCC 37 at RAF 0.166. PDR is the most severe retinopathy stage clinically; HCC weight is the same as other diabetic-retinopathy codes.